We will develop analytically based quidelines and practical procedures for personalized, quality controlled screening and diagnosis in clinical settings. Our goal is improved quality and cost effectiveness of breast cancer detection practices. We will investigate the relative benefits and costs of competing strategies, including the confirmatory value of a screen and economic measures of efficiency. We will categorize strategies according to their preferability for women within specific risk profiles according to all benefit-cost criteria developed. We will develop risk profiles for the ten thousand women in our detection project, determine the value of modality specific features as predictors of the disease, determine which interpretive decision rules most enhance the technical quality of detection modalities and determine which strategies (logical combinations of detection modalities in conjunction with decision rules for recommending a course of action) are best for which risk groups. To transfer our quality control and strategy selection methodologies to other clinical settings, we will prepare a detailed implementation manual. (Work is currently underway on a pilot basis with ACS support).